Cognitive Rehabilitation For People Research Articles

Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia.

Cognitive impairments, particularly memory problems, are a defining feature of the early stages of Alzheimer's disease (AD) and vascular dementia. Cognitive training and cognitive rehabilitation are specific interventional approaches designed to address difficulties with memory and other aspects of cognitive functioning. The present review is an update of previous versions of this review. The main aim of the current review was to evaluate the effectiveness and impact of cognitive training and cognitive rehabilitation for people with mild Alzheimer's disease or vascular dementia in relation to important cognitive and non-cognitive outcomes for the person with dementia and the primary caregiver in the short, medium and long term. The CDCIG Specialized Register, ALOIS, which contains records from MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS and many other clinical trial databases and grey literature sources, was most recently searched on 2 November 2012. Randomised controlled trials (RCTs), published in English, comparing cognitive rehabilitation or cognitive training interventions with control conditions, and reporting relevant outcomes for the person with dementia and/or the family caregiver, were considered for inclusion. Eleven RCTs reporting cognitive training interventions were included in the review. A large number of measures were used in the different studies, and meta-analysis could be conducted for 11 of the primary and secondary outcomes of interest. Several outcomes were not measured in any of the studies. The unit of analysis in the meta-analysis was the change from baseline score. Overall estimates of treatment effect were calculated using a fixed-effect model, and statistical heterogeneity was measured using a standard Chi(2) statistic. One RCT of cognitive rehabilitation was identified, allowing examination of effect sizes, but no meta-analysis could be conducted. Cognitive training was not associated with positive or negative effects in relation to any reported outcomes. The overall quality of the trials was low to moderate. The single RCT of cognitive rehabilitation found promising results in relation to a number of participant and caregiver outcomes, and was generally of high quality. Available evidence regarding cognitive training remains limited, and the quality of the evidence needs to improve. However, there is still no indication of any significant benefit derived from cognitive training. Trial reports indicate that some gains resulting from intervention may not be captured adequately by available standardised outcome measures. The results of the single RCT of cognitive rehabilitation show promise but are preliminary in nature. Further, well-designed studies of cognitive training and cognitive rehabilitation are required to obtain more definitive evidence. Researchers should describe and classify their interventions appropriately using available terminology.

Cognitive rehabilitation for people with early-stage Alzheimer’s disease

Cognitive rehabilitation for people with early-stage Alzheimer’s disease

Goal-Setting in Cognitive Rehabilitation for People with Early-Stage Alzheimer's Disease

This article draws upon findings from a recent randomized controlled trial of cognitive rehabilitation to consider the extent to which people with early-stage Alzheimer's Disease (n = 69) were able to identify individual rehabilitation goals, and what kinds of goals were important to them. For those assigned to receive cognitive rehabilitation (n = 22), we further examine the nature of the goals selected as the basis for therapy, and analyze within-group results with regard to efficacy. All participants were able to identify goals and to rate their performance and satisfaction with performance. Participants assigned to cognitive rehabilitation worked on selected goals, and clinically significant improvements in performance and satisfaction ratings for these goals were corroborated by therapist ratings and goal attainment indicators.

The practical use of goal attainment scaling for people with acquired brain injury who receive cognitive rehabilitation

Objective: To examine the feasibility of and clinical experiences with goal attainment scaling when used for the evaluation of cognitive rehabilitation in people with acquired brain injury. Design: A prospective observational longitudinal study. Setting: A 21-week cognitive rehabilitation programme and a cognitive programme with varying length in two different Dutch rehabilitation centres. Subjects: Forty-eight consecutive patients with acquired brain injury enrolled during a 15-month period. Interventions: Cognitive rehabilitation programme. Main measure: Goal attainment scaling; the number of goals was counted; time to set goals was recorded; the number of different domains in which goals were set was counted; goal attainment scaling score was calculated at baseline, one week after the end of the cognitive rehabilitation programme and at six months follow-up; clinical experiences that could be useful for both clinical and research practice were recorded. Results: The mean (SD) age of the patients was 46.1 (10.7) years; 29 (60%) were male; 186 goals were set with a mean (SD) number of 4 (1) goals per patient. It was possible to set at least three realistic goals per patient within 30 minutes. Most goals were set in the cognitive domain (i.e. memory and attention), followed by the behavioural domain (i.e. fatigue and aggression). Conclusion: It proved possible to set three goals within an acceptable time-frame, to involve patients in the goal-setting procedure, to set realistic goals, and to set goals within relevant domains. Based on clinical experiences, goal attainment scaling is less feasible for research when patients lack insight, or suffer from comorbidity or mood problems.

Internet-enabled exercises and prosthesis for home-based cognitive rehabilitation

The capability of virtual reality to create dynamic three-dimensional realistic environments, within which behavioural responses to stimulus can be assessed, offers many new opportunities in cognitive rehabilitation. This paper proposes a framework for an integrated rehabilitation management system to support the home-based cognitive rehabilitation for people suffering from acquired brain injury. An approach to develop Internet-enabled exercises based on existing clinical activities is presented. These exercises, which incorporate both virtual telephone and computer-interfaced prosthesis, would enable people with memory impairment to perform exercises in their homes under the supervision of trained caregivers.

Functional Neuroimaging and Cognitive Rehabilitation for People with Traumatic Brain Injury

Cognitive deficits are a common consequence of traumatic brain injury. Although such deficits are amenable to rehabilitation, methods for individualizing cognitive interventions are still unrefined. Functional neuroimaging methods such as positron emission tomography and functional magnetic resonance imaging are emerging as possible technologies for measuring and monitoring the cerebral consequences of plasticity associated with brain injury and for evaluating the effectiveness of rehabilitation interventions. Functional neuroimaging may even enable more customized and efficient selection, design, or adaptation of individual cognitive rehabilitation programs. We review the current literature on functional neuroimaging after traumatic brain injury, relating these findings to cognitive rehabilitation. Overall, functional neuroimaging after traumatic brain injury has shown reliable differences in brain activity within several regions of frontal cortex, partly but not uniformly consistent with neuropsychological and structural findings in traumatic brain injury. We also outline a number of promising research opportunities for applying functional neuroimaging in traumatic brain injury settings, along with associated challenges.

Treatment of cognitive problems for people with multiple sclerosis

Cognitive problems in multiple sclerosis (MS) are common and may require treatment. The aim of this study was to evaluate cognitive rehabilitation for people with this disorder. Patients who were impaired on cognitive assessments or reporting significant cognitive problems and were allocated to receive cognitive rehabilitation were asked to complete baseline diaries. Intervention aiming to reduce the practical impact of cognitive impairment was carried out for up to 6 months, during which time patients completed a further set of diaries. Comparing baseline and intervention diaries showed that 20 of 29 (69%) patients appeared to benefit from treatment. It suggests that further evaluation of specific cognitive deficits that benefit from intervention is warranted.

Cognitive training and cognitive rehabilitation for people with early-stage dementia

The aims of psychosocial intervention for people with early-stage dementia are essentially those of rehabilitation. That is to say, the focus should be an attempt to optimize functioning and wellbeing, and to support the person’s social system, thus facilitating continued engagement and participation. It can be argued that a focus on rehabilitation is consistent with the person-centred approach advocated by Kitwood, emphasizing the potential disabling effects of negative social environments and the importance of attempting to counter the resulting excess disability and thus support the selfhood of the person with dementia.

Cognitive rehabilitation for people with schizophrenia and related conditions.

Researchers have consistently found that people with schizophrenia score more poorly than others on a wide array of cognitive tasks and that these deficits persist even when the illness is in remission. The perceived impact of cognitive impairment on day-to-day functioning has led to the development of cognitive rehabilitation techniques intended to remedy these impairments, and thus improve the functioning of people with schizophrenia. To determine whether the use of cognitive rehabilitation techniques is associated with improvement in people with schizophrenia and related conditions. Electronic searches of Biological Abstracts (1982-1997), the Cochrane Schizophrenia Group's Register of trials (2000), EMBASE (1980-1997), LILACS (1982-1997), MEDLINE (1966-1997), PsycLIT (1974-1997) and SCISEARCH (1997) were undertaken. References of all identified studies were handsearched and the first author of each included trial was contacted. The reviewers included randomised trials investigating the impact of cognitive rehabilitation on people with schizophrenia, or related conditions, compared to a placebo intervention, another intervention or standard treatment. This version of the review does not include comparisons of different types of cognitive rehabilitation. Relevant studies were identified and data extracted reliably by two reviewers working independently. In studies which did not specify the reasons for participants dropping out, we assumed that those who had dropped out had experienced no change in the outcome measures. Where possible, Peto odds ratios (OR) and mean differences (MD) were calculated with their 95% confidence intervals (CI). Three small studies met the inclusion criteria. Two compared cognitive rehabilitation to a placebo intervention (total n=84), and the other to occupational therapy (n=33). Although cognitive rehabilitation was as acceptable as placebo and occupational therapy, with low attrition in both groups, no effects were demonstrated on measures of mental state, social behaviour, or cognitive functioning. An effect, in favour of cognitive rehabilitation, on a measure of self-esteem (Rosenberg Self-Esteem Scale, MD 6.3 CI 1.07-11.53 ) is worthy of replication in any future trials. Data are inconclusive and provide no evidence for or against cognitive rehabilitation as a treatment for schizophrenia.

Cognitive rehabilitation for people with schizophrenia and related conditions: A systematic review and meta-analysis

Cognitive rehabilitation for people with schizophrenia and related conditions: A systematic review and meta-analysis

Cognitive Rehabilitation of People with Mental Illness

Abstract Most clinical profiles of schizophrenia place cognitive deficits in its center. Specific information processes that might be deficient include attention, memory, executive functioning, language processing, and psychomotor functioning. Intervention programs are better designed for the specific deficits shown by an individual rather than a generic pattern for all persons with schizophrenia. Errorless learning strategies have been successfully adapted to address specific cognitive deficits.